Large Student Cohorts Research Articles

Impact of panelists\u2019 experience on script concordance test scores of medical students

BackgroundThe evaluation process of French medical students will evolve in the next few years in order to improve assessment validity. Script concordance testing (SCT) offers the possibility to assess medical knowledge alongside clinical reasoning under conditions of uncertainty. In this study, we aimed at comparing the SCT scores of a large cohort of undergraduate medical students, according to the experience level of the reference panel.MethodsIn 2019, the authors developed a 30-item SCT and sent it to experts with varying levels of experience. Data analysis included score comparisons with paired Wilcoxon rank sum tests and concordance analysis with Bland & Altman plots.ResultsA panel of 75 experts was divided into three groups: 31 residents, 21 non-experienced physicians (NEP) and 23 experienced physicians (EP). Among each group, random samples of N = 20, 15 and 10 were selected. A total of 985 students from nine different medical schools participated in the SCT examination. No matter the size of the panel (N = 20, 15 or 10), students’ SCT scores were lower with the NEP group when compared to the resident panel (median score 67.1 vs 69.1, p < 0.0001 if N = 20; 67.2 vs 70.1, p < 0.0001 if N = 15 and 67.7 vs 68.4, p < 0.0001 if N = 10) and with EP compared to NEP (65.4 vs 67.1, p < 0.0001 if N = 20; 66.0 vs 67.2, p < 0.0001 if N = 15 and 62.5 vs 67.7, p < 0.0001 if N = 10). Bland & Altman plots showed good concordances between students’ SCT scores, whatever the experience level of the expert panel.ConclusionsEven though student SCT scores differed statistically according to the expert panels, these differences were rather weak. These results open the possibility of including less-experienced experts in panels for the evaluation of medical students.

Using Fine Arts-Based Training to Develop Observational Skills in Veterinary Students Learning Cytology: A Pilot Study.

Arts-based training has been shown to improve medical students' observational skills. Veterinarians also need keen observational skills. Student veterinarians are expected to develop their observational skills; however, this training is usually not an explicit part of the veterinary curriculum. The impact of arts-based observation training has not been investigated in veterinary students learning cytology. In this pilot study, we compared student descriptions of art and cytology images before and immediately after receiving arts-based observation training. After 10 hours of cytology instruction, we again tested students' observational skills and asked for feedback via a survey. Pre-tests and post-tests were scored following a rubric based on expert descriptions of the images. Scores for art image descriptions were higher for both the immediate and delayed post-tests compared to the pre-test (p < .05). Scores for cytology image descriptions were higher for the immediate post-test than the pre-test, but this difference was not significant. Despite 10 hours of cytology instruction between post-tests, scores for cytology image descriptions were lower for the delayed post-test than the immediate post-test, but again, this difference was not significant. Student feedback on the arts-based observation training was positive. Overall, our results suggest that arts-based training may improve student observational skills, although context could be important, as the improvement in description was only significant for art images. Further investigation with a larger cohort of students and a control group that does not receive arts-based training would be valuable.

Application of Machine Learning Models for Tracking Participant Skills in Cognitive Training.

A key need in cognitive training interventions is to personalize task difficulty to each user and to adapt this difficulty to continually apply appropriate challenges as users improve their skill to perform the tasks. Here we examine how Bayesian filtering approaches, such as hidden Markov models and Kalman filters, and deep-learning approaches, such as the long short-term memory (LSTM) model, may be useful methods to estimate user skill level and predict appropriate task challenges. A possible advantage of these models over commonly used adaptive methods, such as staircases or blockwise adjustment methods that are based only upon recent performance, is that Bayesian filtering and deep learning approaches can model the trajectory of user performance across multiple sessions and incorporate data from multiple users to optimize local estimates. As a proof of concept, we fit data from two large cohorts of undergraduate students performing WM training using an N-back task. Results show that all three models predict appropriate challenges for different users. However, the hidden Markov models were most accurate in predicting participants' performances as a function of provided challenges, and thus, they placed participants at appropriate future challenges. These data provide good support for the potential of machine learning approaches as appropriate methods to personalize task performance to users in tasks that require adaptively determined challenges.

Second-Year Undergraduates Learn Advanced Quantification and Standardization Methods—Internal Standards and Standard Additions—for GC Analysis Techniques with Real World Applications

Exposure to real-life applications of quantitative analysis techniques based on two gas chromatography (GC) experiments was provided to a large cohort of sophomore-level students. In one experiment...

Medical Students' Perceived Interests and Concerns for a Career in Neurosurgery

The factors that attract and concern medical students about a career in neurosurgery have never been clearly characterized or delineated in a large nationwide cohort of medical students intending to pursue a career in neurosurgery. The objective of the present study was to characterize the factors that influence medical student interest in neurosurgery and assess the effects of a formal neurosurgery training course on participants' perceptions of a career in neurosurgery. Before the Medical Student Neurosurgery Training Camp for subinternship preparation, registered students were surveyed about their interest level in neurosurgery, factors that attracted or concerned them about a career in neurosurgery, attendance at a national neurosurgery conference or course, formal clinical neurosurgery exposure in medical school, and whether they had a resident or attending mentor in neurosurgery. At the end of the course, all the participants completed the surveyed again. P < 0.05 was considered significant on Pearson's χ2 and Fisher's exact tests for categorical variables and 2-tailed paired Student's t tests for continuous variables. Of the training camp attendees, >95% completed both pre- and postcourse surveys, including 41 first-year, 19 second-year, 30 third-year, and 5 fourth-year medical school students. The most common factors that concerned students about a career in neurosurgery were work-life balance (76%) and competitiveness (56%). All factors of concern were decreased in the postcourse survey, except for competitiveness. A small cohort (8.4%) of students had no concerns about a career in neurosurgery; this cohort had doubled to 17% after the course (P < 0.05). The students that indicated no concern had a greater postcourse interest level in neurosurgery (95.8 ± 8.7 vs. 86.7 ± 20.5; P < 0.05). Student reasons for an interest in neurosurgery included intellectually stimulating work (94%), interest in neurosciences (93%), effect on patients (84%), innovation and new technology (80%), research opportunities (77%), and prestige (24%). All reasons increased after the course, with the exception of prestige, which decreased to 22%. A training camp for students pursuing a neurosurgery subinternship was effective in providing transparency and positively influencing the factors that attract and concern students about a career in neurosurgery. Characterization of medical student perceptions of neurosurgery from a large, nationwide cohort of students pursuing a subinternship has provided novel data and could help identify factors protecting against burnout later in life.

Cannabis cessation among youth: rates, patterns and academic outcomes in a large prospective cohort of Canadian high school students.

Following cannabis legalization in Canada, a better understanding of the prevalence of unprompted cannabis use reduction and subsequent effects on youth academic outcomes is needed to inform harm reduction and health promotion approaches. We analyzed a longitudinally linked sample (n = 91774) from the COMPASS prospective cohort study of Canadian high school students attending Grades 9-12 in Ontario and Alberta between 2013-2014 and 2016-2017. We investigated the prevalence of spontaneous cannabis use reduction and cessation between grade transitions (Grades 9-10, 10-11, 11-12) and the effect of cessation on academic achievement (current or recent math and English course marks) and rigour (usual homework completion and past-month truancy). Only 14.8% of cannabis users decreased their use between grades. Of these, two-thirds made only incremental downward changes, a pattern which held true for all three transitions. Cessation rates from daily and weekly use decreased every year. After cessation, students had better odds than continuing users (OR = 1.23, 95% CI: 1.03- 1.48) and worse odds than never-users (OR = 0.55, 95% CI: 0.31-0.97) for some subcategories of math performance. Students who quit cannabis universally improved class attendance (OR = 2.48, 95% CI: 1.93-3.19) and homework completion (OR = 2.32, 95% CI: 1.85-2.92) compared to continuing users. Increased academic rigour may underlie any improvements seen in academic performance after cannabis cessation. High school students who use cannabis likely need targeted support to facilitate reduction or cessation and subsequent academic recovery. This indicates that a school-based focus on cannabis harm reduction is justified.

Digital Technologies and Innovative Learning Environments in Schooling: A New Zealand Experience

The rise of innovative learning environments, with multiple teachers and larger cohorts of students, can de-privatise practice as teachers have the opportunity to observe each other teaching. However, they also provide the opportunity for collaboratively planning and teaching, and engaging in reflective dialogue about specific pedagogical approaches to enhance student learning and achievement. This may enable teachers and senior staff to promote effective and sustained student learning. Digitally enabled learning environments with the spatial affordances of innovative learning environments can provide the opportunity for the school environment to be a link to knowledges and understandings within the global world. This article reports on a national online survey of 335 primary and secondary principals’ and teachers’ perceptions of work in innovative learning environments with multiple teachers. Multiple-choice and open-ended questions were analysed. The focus was on exploring the use of digital technologies within schooling in Innovative Learning Environments. The findings indicated that respondents were generally positive about the use of Innovative Learning Environments, particularly as experience of such environments increased. The research also found that cloud-based information communication technology enabled a shared online approach to communications, particularly teachers’ collaborative planning and writing of reports. Nevertheless, regardless of the enhancement of digital technologies, most of the respondents perceived that the effectiveness of the teacher, their relationships with the students and their pedagogical practices remained critical.

Abstract P464: Progression of Obesity and Physical Inactivity in Chilean Medical and Dentistry Schools Students. A Call for Action

Background: In Chile obesity has increased (25.1% to 34%), and sedentary lifestyle has remained at 86.7% since 2010 to 2017 despite National programs and campaigns for improvements. It is unknown the prevalence of these and other lifestyle factors in students of medical careers, the expected future promotors of healthy lifestyles throughout their work. Objectives: To determine prevalence of obesity, physical inactivity, emotional stress, smoking and use of alcohol in first year students at University of Chile Faculties of Medicine and Dentistry at admission and throughout their first academic year. Methods: In a longitudinal randomized sample of 253 students (186 females) who completed the study, weight, height, waist circumference, waist circumference-weight ratio, BMI, food consumption, smoking (Glover-Nilsson Test) alcohol use (AUDIT), perceived stress level (PSS), and physical activity (GPAQ) at the first week, 3 and 6 months after their admission were measured. Cochran Test for dichotomic variables and Friedman test for non-parametric variables were used. Results: Average age was 19.1 ± 0.95 years, and blood pressure (first week) 117.2 ± 14.9 / 68.8 ± 8.7 mm/Hg. All the other results are listed in Table 1. Significant increasing prevalence of obesity (general and abdominal, 6.3% to 10.3%) and physical inactivity (&lt; 600 MET/min/week, 16.6% to 22.9%), and poor eating habits with similar sex trends were found. High level PSS persisted throughout the study. Smoking in 17.8 % the first week without significant changes and harmful alcohol consumption declined significantly since admission (10.7 to 5.1%). Conclusions: Progressive obesity and physical inactivity, persistent highly perceived stress, poor eating habits, prevalence of smoking and harmful consumption of alcohol in first year medical students are of concern. Inclusion of lifestyle counseling in the curriculum and revision of its priorities and structure should be considered. A longer follow-up in a larger student cohort is being planned.

Longitudinal evaluation of attitudes to interprofessional collaboration: time for a change?

ABSTRACT Longitudinal evaluation of interprofessional programming is necessary to understand the impact of interprofessional education (IPE) for collaborative practice. Attitude is one measure of intended behavior. The Interprofessional Attitude Scale (IPAS) was developed as an improved measure to examine the readiness for interprofessional education and collaborative practice. As a means to pilot a protocol for a longitudinal comprehensive evaluation of an interprofessional program with 13 health professional programs in 6 health science faculties, the IPAS was administered over a 3-year period to three cohorts of students. The results of the IPAS indicated no significant differences detected across the 3 years. Although there was a significant difference on the Patient Centredness subscale for Cohorts 2 and 3 the effect size was small. Previous experience in an interprofessional course was a predictor of more positive patient centeredness attitudes, but other IPE experience and years of education were not predictors of any interprofessional attitudes. Students from the Medicine & Dentistry (M&D) faculty ranked significantly lower on the teamwork roles and responsibilities subscale compared to the other faculties, except Rehabilitation Medicine (RM). However, once the outliers in RM were removed, there was a significant difference on this subscale between RM and M&D. This paper outlines the challenges with using the IPAS as part of a comprehensive program evaluation and identifies issues with longitudinal data collection for evaluation with large student cohorts.

Have a question? Just ask it: using an anonymous mobile discussion platform for student engagement and peer interaction to support large group teaching

This article analyses the pilot of an anonymous question and answer mobile application with a large cohort of undergraduate students (460) enrolled on an Operations Strategy Management module. The mobile application allowed students to pose anonymous questions to both peers and staff, create replies and vote on questions posted by other users. The aim of the pilot was to evaluate how this application could be used to enhance communication, engagement and student learning both inside and outside of class time to overcome some of the challenges presented by large cohort teaching. An initial evaluation was undertaken exploring both the analytics attached to the platform and a thematic analysis of the posts. The initial findings of the pilot were positive, with the majority of students installing and regularly accessing the application with use increasing over time. The questions posed demonstrated engagement beyond surface-level memorisation of module content, and there were indications that the application could be beneficial in supporting student community awareness and interaction within large cohorts.

Influenza Vaccination, Self-reported Illness, and Obstacles for Vaccination Among the 2010 ROTC Warrior Forge Cadet Cohort.

This study evaluates a large cohort of college students after the 2009-2010 pandemic H1N1 influenza season. The objective was to assess influenza vaccination status, influenzalike illnesses (ILIs), and other characteristics associated with attaining immunizations. This study was conducted during the summer 2010 the Reserve Officer Training Corps Leadership Development and Assessment Course involving 6272 college students. A voluntary, anonymous questionnaire was administered to assess study objectives. Vaccination rates were 39.9% for pandemic H1N1, 40.6% for seasonal influenza, and 32.6% for receiving both vaccinations. Age less than 25 and having a Reserve Officer Training Corps scholarship were associated with lower odds of receiving vaccinations, whereas entering the nursing field and simultaneous membership in the Army reserve forces were associated with higher odds of vaccination. There are 11.2% of respondents reported having an ILI, including 4.3% with severe ILI. There were 4184 reasons indicated for not attaining influenza vaccinations, which are listed in categorical groupings. A historical anchor for vaccination rates and ILI is provided in a large cohort of college students following the 2009 H1N1 influenza pandemic. Influenza immunization locations were determined, as was self-reported obstacles to receiving vaccinations. These are important results for public health leaders seeking to increase vaccination rates during future influenza seasons.

A pedagogy of care: PGCE students’ experiences of online learning during Covid-19

The article discusses the online teaching and learning experiences of university students during the recent countrywide lockdown and higher education institutional shutdown due to the Covid-19 pandemic. Drawing on philosopher Joan Tronto’s phases of care and associated moral elements, the article reports on survey data from a large cohort of students in the Post Graduate Certificate of Education programme at Stellenbosch University and seeks to analyse the students’ care needs and experiences of care during this period. The aim of the article discussion is not to answer the question whether the university institution offered the students good care during the campus shutdown and remote teaching and learning, but rather to understand the experiences of the students of online teaching and learning during this time.

Gathering Intelligence on Student Information Behavior Using Data Mining

In this paper, we present a novel machine-learning approach that analyzes student assessment scores across a teaching period to predict their final exam performance. One challenge for many universities around the world is identifying the students who are at risk of failing a subject sufficiently early enough to provide proactive interventions that aim to minimize the risk of failure due to several reasons such as the volume of (big) data. We propose a data-driven strategy using machine learning, an application of artificial intelligence that has become popular for extracting knowledge from data by combining strategies and processes from statistics and computer science. By being able to predict what a student's exam performance is ahead of time, interventions can occur, and students can be provided with extra support from their teachers to aid them in achieving the best result possible. In this research, we collected data from a popular information-technology subject at an Australian university and applied a machine-learning algorithm to the data to predict a few hundred students' exam scores. We also developed a framework of learningsupport activities that would be of most benefit to at-risk students to achieve maximum impact before their exam would be conducted. We discovered through our approach that we can accurately predict the bottom 20–30 percent of students at risk, enabling a large cohort of students to be helped through our intervention framework, which we believe can have a positive impact on their future results.

Fully online OSCEs: A large cohort case study.

This article was migrated. The article was marked as recommended. Objective Structured Clinical Examinations (OSCEs) are extensively used for clinical assessment in the health professions. However, current social distancing requirements (including on-campus bans) at many universities have made the co-location of participants for large cohort OSCEs impossible. While there is a developing literature on remote OSCEs, particularly in response to the COVID-19 pandemic, this is dominated by approaches dealing with small participant numbers. This paper describes our recent large scale (n = 361 candidates) implementation of a remotely delivered 2 station OSCE. The planning for this OSCE was extensive and involved comprehensive candidate, examiner and simulated patient orientation and training. Our processes were explicitly designed to develop platform familiarity for all participants and included building on remote tutorial experiences and device testing. Our remote OSCE design and logistics made use of using existing enterprise solutions including videoconferencing, survey and collaboration platforms and allowed extra time between candidates in case of technical issues. We describe our process in detail including examiner, simulated patient, and candidate perspectives to provide precise detail, hopefully assisting other institutions to understand and adopt our approach. Although logistically complex, we have demonstrated that it is possible to deliver a remote OSCE assessment involving a large student cohort with a limited number of stations using commonly available enterprise solutions. We recognise it would be ideal to sample more broadly across stations and examiners, yet given the constraints of our current COVID-19 impacted environment, we believe this to be an appropriate compromise for a non-graduating cohort at this time.

Implementation and evaluation of a near-peer-facilitated medical ethics curriculum for first-year medical students: a pilot study.

The primary objectives of this study were to implement a novel near-peer-facilitated case-based medical ethics curriculum intended for the audience of a large cohort of first-year medical students (n = 193) and to objectively evaluate the immediate efficacy of the curriculum based on pre- and post-session survey responses to ethical quandaries. Two near-peer-facilitated medical ethics case discussion sessions were included in the first-year curriculum during the 2017-2018 academic year. The sessions were designed and led by second-year medical student facilitators under the direction of a faculty mentor and were presented as a year-long curricular thread. First-year students were asked to complete pre- and post-session surveys with ethical questions relevant to each case and session. Students were additionally asked to measure the contribution of discussion sessions to their development as a future physician. Post-session survey results showed that students had a better understanding of specific ethical issues immediately following discussion sessions (p<0.0001). Over three-quarters of students indicated that the near-peer-led medical ethics case discussions contributed somewhat or very much to their development as a future physician. Anecdotal feedback from second-year medical students also suggested that their involvement as facilitators was beneficial to their educational development. Near-peer-facilitated case discussions were an effective strategy for teaching medical ethics to first-year medical students with demonstrated objective improvements in ethical decision-making. Additionally, near-peer discussions of ethical cases and principles with first-year medical students aided in subjective measures of professional development.

OncoSim and OncoWiki: an authentic learning approach to teaching cancer genomics

BackgroundPersonalised medicine is rapidly changing the clinical environment, especially in regard to the management of cancer. However, for the large part, methods used to educate undergraduate students as future biomedical scientists and medical doctors have not reflected these changes. In order to make effective use of advances in cancer genomic knowledge, there is a need to expose students to the challenges of genomic medicine and to do so in a manner that makes this complex information accessible.MethodsThe teaching method developed, OncoSim, is a scaffolded ‘Personal Research’ module option for final year biomedical undergraduate students. It uses an authentic learning approach to teach cancer genomics via simulated cancer patient case studies that have identifiable potential therapeutic targets with associated drug therapies (so-called targeted therapy/precision oncology). In addition, these simulated case studies can be uploaded to a dedicated learning website (OncoWiki) where they can be freely downloaded and used to teach medical students the principles of targeted therapy. A preliminary evaluation of OncoSim was carried out using 3 research tools: (1) online questionnaires; (2) semi-structured interviews; and (3) analysis of whole cohort mark ranges. Thematic analysis was used to code and categorise interview data.ResultsThe teaching materials for OncoSim and the OncoWiki site are freely accessible at https://www.oncowiki.co.uk. Questionnaire data and comparison of whole cohort marks showed OncoSim was at least as effective as alternative choices, and suggested OncoSim provided a valued alternative to traditional laboratory-based projects. No barriers to receptiveness were found. Interview analysis provided 5 broad themes (authentic learning experience; individual challenges; interest in cancer; positive learning experience; supportive structure) supporting the authentic learning aspect of the project, the strong scaffolding provided and the overall effectiveness of the approach.ConclusionsOur preliminary, proof-of-concept, evaluation suggests that OncoSim will be effective in supporting the teaching of genomic medicine to undergraduate students. We plan and hope our study will encourage further formal evaluation in a larger cohort of students, including a control group. The OncoWiki site has the capacity to grow independently as future students create and upload simulated case studies for other students to then download and analyse.

In the digital age, physical learning materials still have their own space in education.

Swinburne University of Technology (SUT) has a large student cohort undertaking anatomy and physiology as part of their core curriculum. Large student cohorts (&gt; 300) impact on the quality and amount of feedback students receive. Teaching and learning materials for students are generally necessary as part of the learning process, and also assist the instructor. This study evaluated whether the introduction of a student laboratory manual enhances student learning and the feedback they receive in the unit of Anatomy and Physiology. It also evaluated the addition of a teaching guide in the teaching experience of tutors in the unit. Anonymous online student and tutor surveys were conducted. Questions regarding the content, presentation and educational value were included in the survey. Students overwhelmingly responded positively to the student laboratory manual. They also believed the amount and quality of feedback received during the unit from their tutor was beneficial to their learning. Students also reported that having a hard copy of their laboratory manual enhanced their learning experience. Therefore, in conclusion the student laboratory manual is a positive introduction into the curriculum of anatomy and physiology. It also identifies potential areas of improvement for the anatomy and physiology curriculum.

Quantifying the medical student learning curve for ECG rhythm strip interpretation using deliberate practice.

Objectives: Obtaining competency in medical skills such as interpretation of electrocardiograms (ECGs) requires repeated practice and feedback. Structured repeated practice and feedback for ECGs is likely not provided to most medical students, so skill development is dependent on opportunistic training during clinical rotations. Our aim was to describe: the amount of deliberate practice completed for learning ECG rhythm strip diagnoses in first year medical students, the learning curve for rhythm strip diagnosis, and student experiences with deliberate practice.Methods: First year medical students from two medical schools were provided with online rhythm strip practice cases. Diagnostic accuracy was measured throughout practice, and students were provided feedback for every case they completed. Total cases practiced and time spent practicing were correlated with their performance during practice and on an exam.Results: 314 of 384 (82%) students consented. The mean number of ECGs each student practiced was 59 (range 0-280), representing 18,466 total instances of deliberate practice. We generated mathematical models that accurately correlated both the number of cases practiced and time spent practicing, with diagnostic accuracy on an exam (p<0.001). For example, students would need to spend on average of 112 minutes and complete 34 practice cases to obtain 75% on an ECG rhythm strip exam. Student satisfaction was high using the online cases.Conclusions: We succeeded in delivering deliberate practice for ECG rhythm strip interpretation to a large cohort of students at 2 medical schools. We quantified a learning curve that estimates the number of cases and practice time required to achieve pre-determined levels of diagnostic accuracy. This data can help inform a competency-based approach to curriculum development.

A professional development program with an assessed ePortfolio: A practical solution for engaging undergraduates with their career development in large student cohorts

Undergraduate biomedical science degree-programs are considered to be non-vocational, with a diverse range of career outcomes. At our university, student and academic feedback indicated that biomedical science students were anxious and uncertain about their career options. In response to this careers anxiety, an in-curriculum, course-wide and assessed professional development program (PDP) was developed and delivered into the biomedical science degree-program by an integrated team of careers educators and biomedical academics. This program aimed to engage a large cohort of biomedical students (&gt;1000) with their career development, improving their careers awareness and reducing their anxiety about careers options. The impacts of the program on students’ career and employability skills development, as well as their self-reported levels of psychological distress, were evaluated with on-line anonymous student surveys. Student engagement with the program was linked with program assessment submission rates and student interactions with the University Careers Service. Completion of the program increased students’ careers knowledge and confidence, enhanced their awareness of career options and employability skills and increased their engagement with the University Careers Service. It did not alter students’ self-reported levels of depression, anxiety and stress, but students who rated themselves poorly on careers awareness and confidence statements were more likely to have severe depression, anxiety and stress. This program provides a practical approach for students’ career and employability skills development in large cohorts, but could be expanded to include an intervention to reduce student anxiety.

Theorems or procedures? Exploring undergraduates’ methods to solve routine problems in linear algebra

While the lion’s share of mathematics education research in linear algebra has been concerned with the conceptual aspects of students’ learning, this study focuses on procedural knowledge that undergraduates can develop in a typical first-year course. The study analyzes the methods that a large cohort of second-semester students applied in a final exam to solve three routine problems: finding a basis for a matrix column space, solving a linear system of equations, and devising a normal to a subspace. The results indicate an inverse relation between the efficiency of the methods that students used and the number of students who used them. This was especially evident in the case of theorems, the application of which was avoided by all but a few students in favor of compound algebraic procedures. Furthermore, the study shows that at the end of an instructional sequence, many students can struggle with choosing an appropriate problem-solving method and carrying it out without mistakes. The analysis of students’ mistakes is leveraged to draw university teachers’ attention to common difficulties in linear algebra.